Big changes for hospitals and clinics in South Africa – leaning heavily on the private sector and NHI

 ·28 Oct 2022

The Department of Public Works and Infrastructure (DPWI) has laid out its plans to improve healthcare infrastructure across South Africa for the next few years, in line with a new plan published for public comment this past week.

The department published the phase 2 documentation of its National Infrastructure Plan 2050 for public comment, detailing the path government will follow in realising its major infrastructure projects over the next 30 years.

In the healthcare sector, the department acknowledged that public healthcare facilities in the country are in extremely poor condition. Maintenance and equipment failures are rife, with significant shortcomings in certain facilities, especially in mental healthcare.

However, the department sings of a bright future for the sector thanks to the National Health Insurance (NHI) bill, which is currently sitting before National Assembly.

The department said that the NHI is a health financing system designed to pool funds together to pay for healthcare and provide access to affordable healthcare for all. It noted that 80% of patients in South Africa are served by the public health service, but 43% of the funding goes to the private sector.

For the government’s future infrastructure plans – which include building more healthcare facilities and clinics, as well as maintaining or completely replacing current structures that have fallen into disarray – it will be leaning heavily into the private sector to help, including through the NHI.

South Africa’s healthcare infrastructure is characterised by:

  • Strong access to public health facilities;
  • A shortage of mental healthcare facilities;
  • 30 to 40 locations underserviced by primary healthcare facilities;
  • A shortage of level 2 and level 3 beds;
  • Difficulties recruiting staff;
  • Facilities are in poor condition, with quality being regarded as “at risk of failure”.

In the years to 2050, the department wants to leverage skills and expertise in the non-profit and private sectors to “work-share” and increase institutional capacity to operate and maintain infrastructure.

Through the implementation of the NHI, the blended financing will result in public and private cooperation in healthcare service provision, infrastructure provision and maintenance, and project financing, the department said.

This also includes having “partnerships” in place between the public and private healthcare sectors for expertise in high-tech specialists and tertiary services like radiology, oncology, neurology and mental health, among others.

“Frameworks must be in place for partnerships between the public and private sectors for infrastructure provision and management,” it said.

The department also said that budgets need to be revised to ensure maintenance and upgrades to existing health facilities. This includes outright replacing about 20% of the clinics in South Africa that are deemed unsafe.

Other long-term plans include:

  • New clinics in 40 locations where access can be improved to meet the target of 5km or 3 minutes of travel to a clinic;
  • Additional hospital and bed capacity through more mental health facilities, realignment of existing facilities, and partnerships with the private sector;
  • Underutilised hospitals being converted to lodges for expecting mothers, caregivers and patients in transit;
  • More education facilities at hospitals.

Over the next three years, the focus is on increasing the number of healthcare facilities in the country. It wants to develop a multi-year project plan aligned with the NHI, and get current facilities to meet minimum standards while repairing and replacing equipment to avoid failures.

The department’s short-term plans are vague, likely given the current uncertainty around the NHI and how it will be implemented.

The National Department of Health has shown that despite criticism and outright opposition to the NHI scheme, it is moving ahead with the plans unabated.

Earlier this month, the department outlined its plans to pool healthcare data from public and private healthcare providers in a national system, and it has proceeded with the phased implementation of the system despite court findings that some aspects of the plan are inconsistent with the constitution.

Private healthcare groups believe that the scheme is unsustainable and unmanageable, given the scale of what the government wants to achieve against the backdrop of how it has already failed in the public healthcare space.

There are also concerns over an exodus of healthcare professionals who refuse to be subject to the scheme’s harsh conditions, as evidenced by the court ruling the department is appealing.

Medical aids have been fighting for their continued existence, given that the NHI scheme envisions a healthcare system with the state entirely in control and little to no room for private healthcare funding.

Read: Big changes coming for schools in South Africa

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